www.cicoa.org careaware options for social workers engaging and supporting family caregivers for...
TRANSCRIPT
www.cicoa.org
CareAware Options for Social Workers
Engaging and Supporting Family Caregivers
for Optimal Client Outcomes
www.cicoa.org
Introductions
Kate Kunk, RN, CIRS-ALindsie Hammans, LSW, CIRS-A
(317) 254-3660CICOA Aging & In-Home Solutions
Area Agency 8
Indiana Association of Area Agencies on Agingof the National Association of Area Agencies on Aging
www.cicoa.org
Introductions, continued…
You are: Fellow alumnus Social worker/Colleague/Employee Family member Caregiver Bystander, neighbor, fellow club member… Taxpayer
Today’s message has broad application—not only professionally, but socially as well
www.cicoa.org
Who’s a caregiver? …some of your clients have caregivers, and some of the family members of
your colleaguesyour neighbors/friends(and perhaps even you)
have caregiving responsibilities.
Caregiving happens regardless of where we are in our lives.
In fact, most of us here today will be caregivers in our lifetime.
www.cicoa.org
For our purposes today, “caregiving” is...
…the providing of direct (unpaid) assistance to a loved one who has a diminished ability or the inability to successfully perform tasks that he/shenormally would be expected to perform independently.
www.cicoa.org
Key learning objectives
1. Identify the extreme social and economic contributions of engaged family caregivers and the necessary caregiver supports to ensure best client outcomes.
2. Define the successful community-based care team as a composite that includes family caregivers and other lesser-considered entities.
3. Articulate barriers to caregiver engagement on the team, as well as the opportunities for overcoming these barriers.
www.cicoa.org
Benefits are Far-ReachingINCREASED ENGAGEMENT
INCREASED PUBLIC AWARENESS + ACCESS TO “SOLUTIONS”
REDUCTIONS Caregiver stress + secondary conditions Risks for abuse and/or neglect Preventable injuries in the home 9-1-1 emergencies + NON-emergency calls Hospital readmissions Unnecessary + premature nursing home admissions
IMPROVED QUALITY OF LIFE FOR ALL HOOSIERS, e.g. YOURSELF!
www.cicoa.org
Caregiving affects a lot of people…everyone, in fact.
1.Caregivers2.Care recipients3.Employers 4.Coworkers of caregivers5.Taxpayers6.All of society
are dramatically affected.
www.cicoa.org
Facts About Caregiving
• There are about 65.7 million family caregivers in the U.S. (29% of the population, 31% of all households)1
• Family caregivers taking care of an elderly person contribute an estimated $522 billion to the U.S. economy annually in uncompensated time and services.2
1 National Alliance for Caregiving, http://www.caregiving.org updated Nov, 20122 Chari, A.V. et al: “The Opportunity Costs of Informal Elder-Care in the United States: New Estimates
from the American Time Use Survey.” Rand Corporation: Health Services Research, Oct 2014. http://www.rand.org/pubs/external_publications/EP66196.html.
www.cicoa.org
Family caregivers
…are a critical extension of our formal healthcare system.
“Caregiving in the U.S.: Executive Summary,” National Alliance for Caregiving in Collaboration with AARP. http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf Nov 2009
www.cicoa.org
For every person living in a nursing home…
…there are at least two persons with equivalent levels of disability living in the community.
“Business, Caregiving and the Bottom Line,” National Caregivers Library. www.caregiverslibrary.org Jun 2009.
www.cicoa.org
The Urgency of Encouraging and Supporting Community-Based Care
Average cost of nursing home care per month in Indiana is currently:
$5,500Average cost per year, per person:
$66,000(Most people entering a nursing home for an
extended period will eventually require Medicaid for payment. Many of these people would prefer, and be eligible for, community-based care so that they can age in place.)
www.cicoa.org
In 2009, the number of persons age 65+ years in the U.S. was 39.6 million.
Very soon (by 2030), that number will nearly double, to 72.1 million.1
Many of these will prefer to age in place, and we need to make it possible for them to do so by preventing injury and premature and unnecessary nursing home admissions.
America’s changing demographics
1 SOURCE: Administration on Aging, Dept of Health & Human Services retrieved from http://www.aoa.acl.gov/Aging_Statistics/index.aspx March 2014
www.cicoa.org
This is not only an individual concern.
It is an individual, family, community, state,
and national crisis.
It is not only an individual and family concern.
And it is in ALL our best interests to engage family caregivers and provide them with the support they need.
The first bottom line
www.cicoa.org
The question is not so much, “How can we engage our clients’ family caregivers in order to obtain their support?”
...but rather, “How can we support our family caregivers in such a way that they are empowered to be consistently engaged for the duration of the journey”
(without turning them into the next generation of care recipients)?
The other bottom line
www.cicoa.org
Overwhelmed with the concept of caregiving in light of other life responsibilities
Stress of family dynamics / personalities Caregiver’s denial of seriousness of the situation (or
unwillingness, or deliberate failure to be involved) Caregiver’s lack of confidence
Incomplete information on hospital dischargeAssignment of tasks by medical team without training Frustration in navigating medical systemCare recipient’s resistance to care
Care recipient’s limited ability / insight to articulate needs Logistics (distance from care recipient, etc.) Financial issues
___________________________________________________________________________________________________________________________________________________________________
Barriers to caregiver engagement
www.cicoa.org
Caregiver’s own personal health*
*Over half (53%) of caregivers indicate that their decline in health since becoming a caregiver compromises their ability to provide care...impacting quality of life.
Barriers to caregiver engagement
“Evercare® Study of Caregivers in Decline,” Evercare® in collaboration with National Alliance for Caregiving. http://www.caregiving.org/data/Caregivers%20in%20Decline%20Study-FINAL-lowres.pdf Sept 2006
www.cicoa.org
Caregivers Often Experience Feelings + Issues Of… Loss/Sorrow/Grief Isolation Exhaustion Powerlessness Strained relationships Resentment Frustration Anger Guilt
creating quite a pool of STRESS!
www.cicoa.org
Caregivers represent increased risk for…
Depression Hypertension Heart Disease Diabetes Type II Stroke Obesity Autoimmune disorders (80+)
not to mention their respective
SECONDARY complications…
www.cicoa.org
Stress manifests in many formsand the symptoms can be…
Cognitive Emotional Physical Behavioral
www.cicoa.org
Often, the greatest reducer of caregiver stress is that of respite—time away from caregiving!
However, there is a huge deficit of information for finding help.
Unfortunately, many Hoosiers don’tknow what resources are available
www.cicoa.org
Introducing the
“P-SM-CR”
formula
for developing caregivers who are strong, healthy, and engaged
Overcoming barriers and engaging/supporting caregivers
www.cicoa.org
The Formula
P+SM+CR = Successful Caregiving
1. Preventive self-care
2. Stress reduction and management
3. Awareness of (and access to) HELP! via community resources, e.g. CICOA
www.cicoa.org
PREVENTIVE SELF-CARE
Annual physicals and diagnostics Fill prescriptions on time—and take them! Proper eating, rest, and hydration MD-approved exercise program Avoid excesses and harmful substances
Keys for a strong, healthy and informed caregiver
www.cicoa.org
STRESS REDUCTION AND MANAGEMENT
Deep breathing Hobbies Humor!!! Journaling Camaraderie (formal & informal) Ask for help Accept help when offered If you are a person of faith, utilize this
Keys for a strong, healthy and informed caregiver
www.cicoa.org
Keys for a strong, healthy and informed caregiver
AWARENESS OF—AND ACCESS TO
HELP! Services through the
Local Area Agencies on Aging
Systems and services in the community
www.cicoa.org
Programs
and
Services
www.cicoa.org
What is an “Area Agency on Aging”?
The National Association of Area Agencies on Aging provide support services: information and referral in-home assistance
/servicesto facilitate independence and relieve caregivers. http://www.eldercare.gov
www.cicoa.org
What is CICOA?
Indiana’s largest Area Agency on Aging
Not-for-profit
8 Indiana counties
Founded in 1974
www.cicoa.org
CICOA’s Mission
CICOA Aging & In-Home Solutions empowers older adults,
those of any age with a disability and family caregivers
to achieve the greatest possible independence, dignity and quality of life.
www.cicoa.org
Examples of Services Available
Case management Personal care assistance Adult day service Adult foster care Home delivered meals Transportation services Medical monitoring system Medication management system Home and vehicle modifications Care transitions
www.cicoa.org
Aging & Disability Resource Center CICOA’S “FRONT DOOR” – (317) 254-3660
Information + referral about almost anything!
(Database of 8,000+ programs and services)
Information + applications RE: public servicesApplications for Medicaid “extra help” for copaysMedicare (SHIP) counselingFree legal clinicLists of residential options, elder law attorneys, food pantries, free clinics
How do I find…where do I go…how do I qualify…
www.cicoa.org
CICOA’S “FRONT DOOR” – (317) 254-3660
Eligibility assessments and applications for CICOA services!
Personal careHome-delivered mealsTransportationMinor home modificationsCaregiver respite
Family caregiver support,
Aging & Disability Resource Center
www.cicoa.org
Family Caregiver Support
Information and referral for caregivers One-on-one counseling Workshops for:
• Caregivers • Clinicians• Community leaders• First responders• Fall prevention• Medication safety• Grandparents raising grandchildren
www.cicoa.org
Impatience? Frustration? Non-compliance? Denial of the need? Indifference? Too much “control?” Long-distance caregivers? Difficulty communicating? Finding timely, relevant services? Limited ability for following instructions?
can help!
What issues do you encounter in working with caregivers?
www.cicoa.org
Care Transitions Team
Social workers who work with hospital personnel to assist with discharge and client follow-up in the community
Work with clients in need of services related to safety, non-medical social concerns, etc.
Information sharing with hospitals—and meeting these needs—can prevent and reduce re-hospitalizations!
www.cicoa.org
Meals and More
MEALS (for 60+) Home-delivered meals for homebound persons Neighborhood meal sites (currently 26 sites)
(Nearly 18 MILLION meals served to date)
AND MORE Health education Farmer’s market vouchers Advocacy and awareness
Elders At the Table Indy Hunger Network
www.cicoa.org
Transportation
Way2Go – Marion County – Taxi Discount Program– Essential Needs– Wheelchair Transportation– Grocery/Shuttle Service
New Freedom Vouchers– Serves persons with disability– The only service in Central Indiana that
can cross county lines (all 8 counties)
www.cicoa.org
Minor Home Modifications
Advocate for “elder friendly” and accessible communities in 8 counties
Assistance with home modifications to facilitate the greatest possible independence and aging in place
Annual “Safe at Home” day
www.cicoa.org
Before After
Minor Home Modifications
www.cicoa.org
In-Home Services and Case Management
Staff of approximately 60 care managers (social workers) who visit clients quarterly to coordinate and monitor client services that are provided by external agencies
www.cicoa.org
Other: Private Insurance VA Aid and Attendance Medicare (short-term only, e.g. for rehab) “Money Follows the Person” (a Medicaid source) “Prior Authorization” (a Medicaid source)
Funding In-Home Assistance
Private purchase of services CHOICE Medicaid Aged & Disabled Waiver Medicaid Traumatic Brain Injury Waiver
www.cicoa.org
STATE Funding In-Home Assistance Through CICOA
Eligibility is determined by:
1. Physical criteria
2. Financial criteria (income + assets)
www.cicoa.org
Physical criteria3 for Waiver (or a skilled need)
2 for CHOICE
Cognition Medication management Feeding Toileting tasks Mobility Transferring Dressing Bathing
www.cicoa.org
Financial criteria2015
CHOICETotal assets: $500,000
(INC. house/car)
Income max:
None
(client pays a cost share if
income is 151% or more over the poverty level)
Medicaid A&D WaiverTotal assets: $2000 (single)
(NOT inc. house/car)
Total income max:
$2,199 per month
(must use Miller’s Trust if over the limit)
www.cicoa.org
There’s No Place Like Home!
94% of older adults want to remain independent, living in their homes and communities as they age.•
Average monthly cost, Indiana nursing home care $5,500 ($66,000/year) EXAMPLE of savings: Average monthly cost for CHOICE-funded care (in-home) = less than $700
www.cicoa.org
Know your own Area Agency on Aging—develop a good working relationship with them o Know how to make a referralo Call us for an in-service presentation!
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _
Be a good neighbor, club member, faith affiliate —share our contact information socially_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _
Call your local AAA for information, referral, or an eligibility assessment for your loved one (be a proactive caregiver who is strong, healthy, engaged!)
What Can Social Workers Do?
YOUR LOCAL AAA
www.cicoa.org
1. Obtain a supply of business cards and hand one to someone who needs us (or to his/her caregiver).
▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬
2. Call the ADRC to refer someone over the phone.▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬ ▬
3. (IF IN AREA “8”)—online:Go to www.cicoa.org
ServicesAging & Disability Resource Center Professonal Intake Form
(Password protected – the password is 4755, and usually must be entered twice)
*Involving an AAA is easy
YOUR LOCAL AAA
www.cicoa.org
ADULT PROTECTIVE
SERVICESFamily & Social Services Admin
INFORMATIONONLY
(Ideal for information needs unrelated to aging,
disability, and caregiving.)
IMMINENT DANGER
(for adults who are “…physically or
mentally incapacitated and
reported as abused, neglected or exploited.”)
__________________________________________________________________
INFORMATION REFERRAL
TANGIBLE FORMS OF ASSISTANCE FOR
INDEPENDENCE
(Anyone of any age with
a disability—long term and duration of need.)
(317) 254-3660(800) 992-6978
When is it appropriate to call…
www.cicoa.org
The overall positive impact of caregiving on American society is profound.
However, we know that no one person can do it all for another.
It is time to recognize, include, support, and lead this extremely valuable resource,
for all our mutual benefit.The sooner we do this, the better.
www.cicoa.org
(317) 254–3660
Independence.Dignity.Quality of life.
www.cicoa.org
Q&A and
Discussion